Individual
MR. GEORGE ALLAN TERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW-R
Contact information
Practice address
201 E GREEN ST, ITHACA, NY 14850-5635
(607) 274-6288
(607) 274-6280
Mailing address
9857 CASE RD, INTERLAKEN, NY 14847-9751
(607) 387-4813
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R046798-1
NY
Other
Enumeration date
12/21/2006
Last updated
07/08/2007
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